It may not be pleasant to talk about it, but prostate cancer is the most common type of cancer among men in the U.S., aside from skin cancer, according to the Centers for Disease Control (CDC). And within a lifetime, men have a 1 in 7 chance of developing this type of cancer.
And although the number of men developing this type of cancer seems to be increasing, the death rate is declining. Scott & White urologist and chief of laparoscopy and endourology, Patrick Lowry, MD, said the decline in deaths is due in large part to the advancements that have been made in treating the disease.
“The treatments now are pretty close to the same as what they were twenty years ago, but they’re much better,” Dr. Lowry said.
Which treatments have improved?
“Our radiation [treatments] are better than they’ve ever been,” Dr. Lowry said. “It’s the same radiation, but there’s less exposure to the nearby organs, which means fewer side effects.”
And doctors are finding better ways to employ radiation with treatments such as brachytherapy, which is the placement of radiation “seeds” into the cancerous tissue. The seeds are only about the size of a grain of rice and the radiation they emit only travels a few millimeters.
“It’s a day surgery procedure where radioactive pellets are spaced out in the prostate and the radiation kills the cancer,” the doctor said. “But because the radiation is all in these pellets, so there is less spread to the nearby organs and fewer side effects.”
Even though this procedure has been successful in shrinking prostate cancer, brachytherapy is more effective on localized cancer—cancers caught early.
“It doesn’t work well on aggressive cancers,” Dr. Lowry said. “And we don’t want to use it if we’re concerned that the cancer is leaving the prostate—spreading to other areas of the body.”
For decades, surgeons have performed radical prostatectomies to treat prostate cancer. And although the surgical procedure is still the gold standard for treating this disease, doctors know more today about the anatomy of the prostate gland than they did 20 years ago.
Knowing more about the area in which they are operating helps surgeons better preserve important nerves that will improve continence and sexual performance issues that often plague prostate cancer patients.
“Additionally, There’s a lot more we can do for incontinence after surgery,” Dr Lowry said. “The biggest advance we’ve had in our area in the last five years is physical therapists who specialize in working with the pelvic floor muscles.”
Patients who see these therapists have fewer problems with incontinence and return to normal functioning sooner and stronger.
Other advances in surgical treatment include laparoscopic and robotic prostatectomies, which are equivalent to the open prostatectomy, but are less invasive.
“With these procedures, the results are just as good for cancer control, potency and incontinence,” he said. “Patients get better faster, go home from the hospital sooner and on average have significantly less bleeding.”
What advancements have been made in prevention and detection?
The biggest advancement in the last 20 years has been the implementation of the blood test that detects Prostate Specific Antigen (PSA) levels.
“Before [this test] we didn’t have any way of finding prostate cancer except for a prostate exam,” Dr. Lowry said. “By the time you can feel a bump on a prostate, it’s usually locally advanced. Now we can catch it early.”
And with the information gathered from the PSA blood test and subsequent biopsies, doctors can now determine how aggressive the cancer is, the size of the cancer and whether or not it’s life-threatening.
While advancements in testing and detection are saving lives, there also steps men can take to lower their risk of developing prostate cancer.
“We do know that a low-fat, healthy diet is associated with a lower prostate cancer risk,” Dr. Lowry said. “And there’s a new study that says exercise can help as well.”
It is also important to ask your doctor about the PSA blood test if you are over 50, African-American, or have a family history of the disease.
“The key is catching it early,” the doctor said. “If it’s caught early, then we have an excellent chance of curing it.”
What does the future hold for prostate cancer treatment?
“I think that we’re going to find better ways to identify it early, and we’re going to find better ways to distinguish which cancers are going to be a threat to someone’s life and which ones are not.”
Dr. Lowry is also hopeful that someday treatment of prostate cancer won’t require surgery or radiation.
“As opposed to what we had 20 years ago, we certainly take better care of prostate cancer than we used to.”